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  • Chronic Kidney Disease (CKD) and Diabetes Treatment

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    RanadaPrasadSaha
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    MedicYatra provides the safe & best Chronic Kidney Disease (CKD) and Diabetes treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com

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    MedicYatra provides the safe & best Chronic Kidney Disease (CKD) and Diabetes treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com

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    Attribution Non-Commercial (BY-NC)
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    Sinalizar o conteúdo como inadequado
    7 visualizações35 páginas

    Chronic Kidney Disease (CKD) and Diabetes Treatment

    Enviado por

    RanadaPrasadSaha
    MedicYatra provides the safe & best Chronic Kidney Disease (CKD) and Diabetes treatment and procedure at its affiliate & trusted hospitals & clinics in various metro cities of India, like Mumbai, Delhi, Bangalore, Chennai, Pune etc.Our Associate Board certified doctors are extensively trained and vastly experienced and have performed hundreds of such cases at our state of the art JCI accredited hospitals & Clinics. Our aim is to provide you the best of the services at the most affordable costs. Don't forget to say hi at info@medicyatra.com

    Direitos autorais:

    Attribution Non-Commercial (BY-NC)
    Baixe no formato PPT, PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    de 35

    Email: enquiry@medicyatra.

    com

    Chronic Kidney Disease (CKD) and Diabetes


    .

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Medic Yatra Kidney Foundation

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Current Terminology
    Kidney, not Renal (or Reno) CKD, not CRF DKD (= diabetic nephropathy) AKI, not ARF Still ESRD (End Stage Renal Disease) Still RRT (Renal Replacement Therapy)

    Copyright @ Forever Medic Online Pvt. Ltd

    ESRD Incidence Counts and Rates by Primary Diagnosis (USRDS, 2006)

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Better CKD Management?

    Email: enquiry@medicyatra.com

    Glomerulus = filtering unit

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Importance of Diabetic Kidney Disease

    Kidney disease as diabetic complication:


    30% of Type 1 Diabetes 40% of Type 2 Diabetes

    CKD amplifies CVD risk of diabetes

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Diabetic Kidney Disease Screening


    WHEN
    Type 1: after 5 years, then annually Type 2: at diagnosis, then annually

    HOW
    Albumin-to-Creatinine ratio in random urine
    Microalbuminuria = 30-300 mg/g Macroproteinuria

    Estimate GFR (eGFR) from serum creatinine using formulas Retinopathy: useful clue
    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Stages of CKD
    Stage 1 2 3 4 5 6 ICD-9 585.1 585.2 585.3 585.4 585.5 585.6 GFR
    (mL/min/1.73M2)

    > 91 + damage
    60-89 + damage

    30-59 15-29 < 15 ESRD on RRT

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Action Plan in the Clinic


    Determine AKI vs. CKD? Estimate GFR and rate of decline Identify kidney disease requiring specific Rx Slow progression of CKD Review medications Identify + treat systemic complications Prepare for replacement therapy Depending on CKD Stage
    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Formulas for Estimating GFR


    Cockcroft-Gault MDRD (Modification of Diet in Renal Disease Study)
    GFR calculator (www.kidney.org)

    GFR depends on:


    Serum creatinine Age Gender Race
    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Interventions to Slow CKD Progression


    Strong evidence
    Blood pressure control ACEI / ARB Glucose control in DM

    Weaker evidence
    Protein restriction Lowering LDL cholesterol

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Management of Albuminuria in Normotensive Diabetic


    Normotensive DM patients with macroalbuminuria should be treated with ACEI / ARB Treatment with an ACE inhibitor or an ARB should be considered in normotensive persons with diabetes and microalbuminuria
    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    AKI Superimposed on CKD


    Dehydration BP too low Obstruction Contract dye Drugs
    Nephrotoxic or allergic or hemodynamic NSAID (including Cox-2 inhibitors) ACEI / ARB
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    Email: enquiry@medicyatra.com

    Systemic Complications of CKD


    Hypertension Cardiovascular disease Anemia Calcium-phosphorus-parathyroid

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    Email: enquiry@medicyatra.com

    American Heart Association


    Patients with CKD
    Should be considered as highest-risk group for CVD Should be treated as such

    Sarnak, Circ, 2004


    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Left Ventricular Hypertrophy in CKD

    Risk factors: HTN and Anemia


    Copyright @ Forever Medic Online Pvt. Ltd 1999; Foley, KI, 1995 Levin, AJKD.

    Email: enquiry@medicyatra.com

    Erythropoietin Stimulating Agent in CKD


    Administration (SQ q 1-4 wk)
    Epoietin- (start 75-150 units/kg) Darbepoetin (start 0.45 g/kg)

    Target Hgb (11-12 g/dL) Adverse effects


    Iron deficiency (may need IV iron) Hypertension

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    What is Renal Diet?


    Low sodium Low potassium
    What about DASH?

    Low phosphorus
    Adding glucose and fat targets?

    Should be individualized

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Symptoms of Uremia
    None or subtle Fatigue, lack of energy Anorexia (nausea/vomiting) Sleep disturbance Impaired cognitive function Impotence

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    When to Start Replacement Therapy


    Phophorus higher than hct Pale and sallow Needs a razor blade to scratch the itch Vomiting day & night Legs twitching Hands flapping Uremic smell you cannot stand

    Too late!! Should start no later than mildly symptomatic Copyright mL/min Usually GFR 7-8@ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Preparation for RRT


    GFR 20 mL/min (depends on rate of decline)
    Early CKD education (including diet)

    Early nephrology referral for co-management (delineate responsibilities)


    Arm vein preservation

    Copyright @ Forever Medic Online Pvt. Ltd

    Email: enquiry@medicyatra.com

    Copyright @ Forever Medic Online Pvt. Ltd

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